Apparatus for practising resuscitation by insufflation and external heart massage

ABSTRACT

A practising apparatus for a training of resuscitation by synchronized insufflation and external heart massage in which a dummy torso is provided with an imitation thorax and imitation lungs. Writing means associated with said imitation thorax and lungs records on an advanceable record sheet the movements of the lungs and thorax in insufflation and heart massage.

United States Patent [191 Laerdal [111 3,736,362 1 May 29,1973

[54] APPARATUS FOR PRACTISING RESUSCITATION BY INSUFFLATION AND EXTERNALHEART MASSAGE [76] Inventor: Asmund S. Laerdal, Stavanger, Norway [22]Filed: Dec. 4, 1970 [21] App1.No.: 95,078

[30] Foreign Application Priority Data Dec. 11, 1969 Germany ..P 19 62083.8

[52] U.S. Cl ..35/17 [51] Int. Cl ..G09b 23/32 [58] Field of Search..35/17 [56] References Cited UNITED STATES PATENTS 2,054,996 9/1936Upson ..35/17 X 3,010,223 11/1961 Alderson ..35/17 3,049,811 8/1962Ruben ....35/1 7 3,276,147 10/1966 Padellford ....35/l7 3,562,924 2/1971Baermann..... ....35/l7 3,562,925 2/1971 Baermann ....35/17 3,568,3333/1971 Clark ..35/17 Primary Examiner-Harland S. SkogquistAttorney-Mason, Fenwick & Lawrence [57] ABSTRACT A practising apparatusfor a training of resuscitation by synchronized insufflation andexternal heart massage in which a dummy torso is provided with animitation thorax and imitation lungs. Writing means associated with saidimitation thorax and lungs records on an advanceable record sheet themovements of the lungs and thorax in insufflation and heart massage.

9 Claims, 11 Drawing Figures APPARATUS FOR PRACTISING RESUSCITATION BYINSUFFLATION AND EXTERNAL HEART MASSAGE The present invention relates toan apparatus for practicing resuscitation by insufilation and externalheart massage.

The main cause of death resulting from accidents or other suddenlyoccurring medical emergencies is stopping of breathing and of heartbeat. It is, therefore, necessary to give first aid training to thegreatest possible number of individuals. It is best for artificiallyinduced breathing (mouth-to-mouth or mouth-to-nose) and massage of theheart to be applied simultaneously. This combined method ofresuscitation, however, requires thorough schooling of the personrendering assistance, since performing the resuscitation successfullyand without causing harm to the injured person depends on correct andsynchronized insufilation and heart massage, freeing of the respiratorypassages and blowing in the correct amount of air, as well as on theknowledge of the proper part of the chest and the right magnitude anddirection of the pressure exerted in heart massage.

According to the present invention there is provided practicingapparatus for resuscitation by synchronized insufflation and externalheart massage, such apparatus comprising a dummy torso provided withimitation respiratory organs and an imitation thorax, a recording deviceadapted to receive and advance a record sheet in an advancing direction,writing means adapted to write on said record sheet and means to movethe writing means transverse to the advancing direction in response tomovement of the imitation respiratory organs and thorax during theinsufflation and heart massage.

Such an apparatus can automatically provide a written record of theexercises, which record is always available for comparison purposes andfor making out certificates, and which is independent of the instructorand does not require his presence when the certificate is drawn 'up.

Dependent on the type of motive equipment, control of the moving meansmay be by electrical, hydraulic or pneumatic means, the movements causedby the resuscitation directly influencing electric potentiometers orpressure generators such as piston and cylinder arrangements or bellows.Preferably, however, the movements are mechanically transmitted to therecording device, especially when the latter is adapted to be insertedinto the body of the dummy or is integrally built therein, as ispreferred.

The mechanical connection between the mobile elements of the simulatedthorax and the simulated lungs and the displacement drive is suitably soconstructed that it is established automatically, if possible withoutany further manipulation.

In particular, when only one person rendering assistance practices thecombined heart massage and insufflation resuscitation it is possible totransmit the signals of insufflation and of heart massage to a writinginstrument associated with both processes of movement since, as a resultof the necessarily separate motive pulses of insufllation and heartmassage both processes can also be clearly separated in a single traceof graph on the record sheet. When two persons render assistance, one ofthem performing insufflation and the other heart massage, it is possiblefor overlapping of insufflation and heart massage compression withrespect to time, which may not always be clearly separable in one traceof graph, especially with regard to their differing duration. In apreferred embodiment of the apparatus two separate writing instruments,movable independently of one another, are therefore provided, one ofthem being associated with the insufflation movements and the other withthe movements resulting from heart compression.

It is of importance for the person or persons rendering assistance tocarry out, prior to and during the resuscitation, various measures andchecks which are vital in a real case. For example, the head of thedummy may be attached to the body so as to be turnable, inclinable orstretchable, in order on the one hand, by turning the head sideways toenable vomit accumulated in the respiratory tracts to flow off, and onthe other hand, by inclining or pulling the head remove strangulationsor constrictions of the respiratory passages. After these manipulationsthe spontaneous pulse of the patient may resume already after a fewstrokes of insufflation. For this purpose there is provided, for exampleat the location of the carotid artery, a corresponding imitation whichthe person rendering assistance may investigate by feel. Repeatedfeeling of the pulse should also be carried out during further progressof the resuscitation so as to recognize the amount of resumption ofspontaneous heart-beat and to be able to decide whether furthertreatment should be given. Another sign of arrested activity of theheart, apart from a missing pulse in the great artery, is the dilationof the pupils of the eyes. Relative changes in the width of the pupilsare particularly valuable indications of the effectiveness of the bloodcirculation caused by the heart massage. Thus the trainee should examinethe condition of the pupils by opening the eye lid. Finally, thepressure of the hands performing the heart massage should not be exertedbeyond a specific region of the sternum, so as to avoid fracturing ofribs and inadequate compression of the heart.

In accordance with a further particularly preferred embodiment of theinvention one or more, but preferably all, of these spots of the dummywhich are to be investigated by feel or which are not to be pressurizedare provided with actuation devices which individually signal that thenecessary manipulation has been performed or that the thorax has wronglybeen pressurized beyond the region of the sternum suitable for heartcompression, by means of signals to individual writing instrumentsprovided for this purpose. These writing instruments draw the signals inthe form of YES-NO statements by lateral deflection or by superposing,preferably in different colors, onto the record sheet of the recordingdevice. The control drives and associated actuation devices for theabove mentioned YES-NO signals operate preferably electrically orpneumatically or hydraulically. Mixed control systems are alsoconceivable.

The drive for advancing the record sheet, which sheet is suitably storedin the form of a roll and the inscribed portion of which protrudeslaterally from the body of the dummy if a writing device accommodatedwithin the body of the dummy is involved, advantageously has asynchronous motor the rate of rotation of which depends on the frequencyof the electric A.C. supply grid to which the training apparatus isconnected. Record sheet material having a time scale printed thereon maybe used in this case. In the transverse direction of the sheet apressure scale, a volume scale and/or a scale for the measurement of thebowing of the sternum during the simulated heart compression may bepresent. In this way the insufllation and heart massage inducedmovements can be quantitatively read in terms of time, rhythm, volume,pressure and extent of bowing of the sternum. The record sheet may,however, alternatively be advanced by a battery fed electromotor or by awindable spring mechanism. In these cases the time-constant advance ofthe record sheet is not ensured. A rhythmic timing device in the form ofa clockwork mechanism or of an electric pulse generator is thereforeassociated with the writing device, the mechanism drawing a secondsscale on the record sheet by means of a writing instrument.

The invention will be better understood from the following description,of oneembodirnent of apparatus according to the invention, which isgiven, merely by way of example, reference being made to theaccompanying drawings, in which:

FIG. 1 is a side elevation of the imitation thorax and of the devicetransmitting movements to the recording device disposed within thetorso, the latter having been omitted from this Figure;

FIG. 2 is a view of the apparatus of FIG. 1 as seen in the longitudinaldirection of the torso;

FIG. 3 is a plan view of the apparatus of FIG. 1, the imitation lungsbeing indicated;

FIG. 4 is a side view of the imitation lungs with mechanical device formoving the writing member;

FIG. 5 shows three views of a device for simulating a changeable pupilof the eye;

FIG. 6 shows the head of the dummy in two oflset positions and with openeyelid;

FIG. 7 is a schematic drawing of the human thorax and of the heartcontained therein;

FIG. 8 is an overall view of the dummy in position for the practice offirst aid;

FIG. 9 shows an electromagnet having a spring loaded armature, and anassociated switch;

.FIG. 10' shows schematically a section through the thorax and head ofthe dummy and through the built-in recording device; and

FIG. 11 shows the telescopable limbs of the dummy.

FIGS. 1 and 2 illustrate the arrangement of a steel band 1 simulatingthe thorax and its mechanical, motion-transmitting connection with thedisplacement drive 2 of a writing instrument 3 of a recording device.The steelband 1 is secured to the back support 5 of the dummy andsurrounds the body space transversely of the body. A rod 6 projectinginto the interior of the body, substantially perpendicular to the backsupport, is attached to the apex of the steelband 1. The rod 6 isaxially displaceable, guided in a frame 7 and has a knob 8 situatedslightly above the center of the sternum region represented inbroken-lines in FIGS. 1 and 2. The knob 8 serves to receive the pressureof the hand performing heart massage (see FIG. 8). The steelband 1 canbe flexed, against increasing resistance, beyond the position 8' shownin broken lines in FIG. 2 and substantially corresponding to thedeflection necessary for a successful heart compression. The steelband 1is stiffened by additional spring elements 10 which can be pretensionedor replaced by springs of different characteristics, to enable theresistance to deformation to be varied for the purpose of simulating theresistance of the thorax of patients of various weights and ages.

The means 2 for moving the writing instrument or pen 3 for recording theheart compression is guided by a rod 11, substantially perpendicular tothe rod 6, also longitudinally displaceable in the frame 7, and is thusin a position to perform a movement parallel to the plane of the recordsheet 12, the writing tip of the pen 3 contacting the sheet 12. Thesheet 12 may be advanced by a synchronous drive means 13 engaging inlateral perforations 14 of the sheet 12 by means of one or twosprockets. It is possible to ensure that the writing instruments onlycontact the surface of the sheet when the drive means of the sheet isoperational by raising the sheet at this time.

A slotted member 15 is secured to the rod 11 and extends in the plane ofmovement of the rods 11 and 6 at an angle to their direction ofmovement. An actuating element in the form of a roll 16 secured to therod 6 engages in the slot of the member 15. When the knob 8 and thus therod 6 is depressed, with simultaneous deformation of the steelband 1 dueto the pressure necessary for heart massage, the guide means 15 slidesalong the roll 16 and displaces the rod 11, and thus moves the pen 3transverse to the direction of advance of the sheet 12. This movementproceeds as a function of the extent of depression of the rod 6 so thatthe lateral deflection of the pen represents a direct measure of thedeformation of the steelband 1 simulating the resistance of the thorax,and thus of the heart massage pressure exerted on the knob 8. For thesake of clarity of the transmission of movements the rod 6, the roll 16,the guide means 15 and the displacement drive 2 are drawn in normalelevation in the at-rest position, while the same elements areillustrated in cross-hatched form after their displacement by a specificpressure exerted on the knob 8.

FIG. 2 indicates by means of the setting knobs l7 and 18 that therecording device is combined with a rhythmic timer 19 which may serve toapply a time scale to the record sheet and/or to simulate the reactionsof the human body heartbeat, change of width of pupils occurring duringresuscitation. The two setting knobs l7 and 18 may, for example, beprovided for the purpose of selecting a specific pulse frequency and forthe timing of a signal energizing an electromagnet.

By means of such a rhythmic timing device 19 a pulse of preferablyvariable frequency can be simulated in the imitation artery (FIG. 6)which should be investigated by feel, and in this way the trainee maylearn how to feel the pulse and acquire the feel of pulse frequencies.After the exercise has begun success of the trainees efforts can besimulated by delivering an artificial pulse switched on after somedelay. For the same purpose therhythmic timer may, after a specificdelay, actuate a device for changing the width of the pupils (FIG. 5) ofthe eyes.

With a synchronized drive of the record sheet advancing device such arhythmic timer may, of course, be driven by the sheet advancing deviceand vice versa. Moreover, the transmission of signals from the rhythmictimer to the pulse imitator may be by electrical, pneumatic or hydraulicmeans. In the first case an electromagnet having a spring loadedarmature can replace the imitation artery by executing suitable knockingmovements. Such an electromagnet may, however, also execute knockingpulses on a tube provided as imitation artery and filled with apneumatic or hydraulic medium. The change in the pupils of the eyes can,for example, be simulated by an electrically released visual signal.Where a pneumatic or hydraulic transmission of signals is used, theimitation artery may be directly pressurized by the rhythmic timer via atube connection, conforming to the rhythm of heartbeat. Production ofpneumatic or of hydraulic pulses by the rhythmic timer may be efiectedby appropriate actuation of a valve to which a pressure accumulator or apressure generator is connected. The pressure strokes corresponding tothe rhythm of pulse frequency set at any given time can also be producedin a closed system by exertion of appropriate pressure on a deformableaccumulator containing a pneumatic or hydraulic pressure medium.

The rhythmic timer may be coupled with a summation mechanism whichreceives the insufflations and/or particularly the heart compressionsperformed and adds them up over a predetermined period of time.

The summation mechanism may be mechanically connected, e.g., in the formof a gearing, to the mobile element or elements, via a latch coupling.If, within a predetermined time, the trainee achieves the specifiednumber of heart compressions with adequate deflection of the thorax, orthe specified number of insufilations with an adequate volume of airblown in, a signal is given. If the movements have been performed at toolong intervals or with insufficient intensity, the signal is not given.The rhythmic timer switches on the artificial pulse or the change in thepupils as soon as the summation mechanism gives the signal indicatingthe successful execution of the exercise.

FIGS. 3 and 4 show the arrangement of the pouch simulating the lungs.The pouch can be inflated via the line 21 communicating with therespiratory passages of the head of the dummy so as to simulateinsufflation. A rod 23 is secured to the initially flat, upper wall 22of the pouch. The rod 23 projects, substantially perpendicularly to theback support 5, into the interior of the torso and is axiallydisplaceable, guided in the frame 7. The position assumed by the upperwall 22 of the pouch when the latter is fully inflated is shown at 24 inFIG. 4, in broken lines. The pouch expands against the resistance of itsown elasticity and against the resistance of two additional springelements 25. The pretensioning of these may be adjustable and/or thesprings may be replaced by others of different characteristics, so thatthe resistance to inflation can be adjusted to a variety of values,especially to simulate the resistance to insufflation of constricted airpassages.

The support 26 of a writing instrument 27 provided for recording theinsufflation strokes has a rod 28 supported in the frame 7 so as to .bedisplaceable in a direction perpendicular to the rod 23. A slotted guide29 is secured to the rod 28, the lower portion of the guide extendingparallel to the rod 23 and its upper region extending in the plane ofmovement of rods 28 and 23 and at an angle to their direction ofmovement. An actuation element in the form of a roll 30 is secured tothe rod 23 and engages in the slot of the guide 29. When the pouch 20 isinflated its upper wall 22 rises to the position 24 taking with it therod 23 and the roll 30, which thereby shifts the guide means 29 and thesupport 26 and the pen 27, transversely of the direction of advance ofthe sheet 12 and over the plane of writing. Here too, for the sake ofclarity, the rod 23, the roll 30, the guide 29 and the support drive 26have been drawn in normal elevation, while after inflation of the pouch20 by the insufilation strokes the same elements arrive at the positionillustrated in cross-hatched form. The traces of graph 31, for therhythm of the heart massage, and 32, for the rhythm of insufflation, areformed in this way, these traces being shown side by side in FIG. 1. Theportion of the guide 29 extending toward the rod 23 serves to preventthe compression of the imitation thorax causing a deflection of thewriting instrument associated with the insufflation strokes.

Four additional writing instruments 33 can be seen in FIGS. 1 and 3 butthese instruments are not displaceable across the direction of travel ofthe record sheet 12. These writing instruments are adapted to be appliedto the writing surface of the sheet 12 by means of moving coilelectromagnets 34 having spring loaded plunger type armatures. They arewriting instruments for recording YES-NO signals such as serve forexample for watching the position of the head, for feeling the pulse andfor correct application of the hand when practicing heart massage. Forthe latter purpose there are provided at the locations 35 of FIG. 3, allaround the application point represented by knob 8, not shown contactswhich switch on one of the writing instruments 33 as a signal for wrongapplication of the hand or exertion of the wrong pressure when pressureis exerted at these points 35.

FIG. 5 shows the imitation of an eye 36 having a funnel-like narrowingcavity 37 containing a granular material 38. As is shown by thecross-sectional illustration of the eye, a pin 39 is situated at thebottom of the funnel 37 which pin is adapted to be moved upwards ordownwards as indicated by the two arrows. In the position illustratedthe pin 39 terminates at the bottom of the funnel 37 so that thegranular material or powder 38 fills the lower part of the funnel 37.When the pin 39 descends the material 38 flows into the pin shaft 40underneath the funnel so that from the direction of the wider portion ofthe funnel, and thus looking at the eye, one sees only a small surface41 of material. When, on the other hand, the pin is introduced into thefunnel space it displaces some of the material 38 so that the latterrises in the funnel and forms a larger surface 42 visible from theoutside. This arrangement which is used to simulate changes of the pupilof the eye is illustrated at its extreme forms'in FIG. 5, as a largepupil above the cross-sectional representation and as a small pupilbelow the cross-sectional representation.

In the illustrated embodiment of the apparatus the movement of the pinis actuated by an electromagnetic drive, e.g., a spring loaded movingcoil magnet as shown in FIG. 9 yet to be discussed.

The pin could, of course, also be moved by means of a pneumatic orhydraulic arrangement, e.g., a piston and cylinder arrangement, if therhythmic timer is constructed so as to provide the correspondingsignals, i.e., when it produces signals in the form of pressure impulsesor triggers off such signals by means of suitable valve movements.Another possibility of altering the visible surface of a materialcontained in the funnel is for the material to consist of resilientlycompressible flakes to which iron particles are attached. The pin thenserves as the stationary core of an electromagnet. When this isenergized the flaky material compresses toward the magnet and forms asmaller visible surface in the funnel. When the electromagnet isde-energized the material expands as a result of the resilience of theflakes and spreads out in the wider portion of the funnel, thus forminga larger surface. The simulated changes of pupils here described canadvantageously be controlled substantially continuously.

The head of the dummy illustrated in FIG. 6 is adapted to be turnedrelative to the body (removal of a secretion obstructing the respiratorytract) or to be stretched backwards (freeing of the respiratorypassages). Since these head movements are a necessary part of theexercise they are transmitted for recording purposes to writinginstruments 33 provided for this purpose, by means of contacts (notshown) arranged at suitable points of the head-neck connection, e.g.,between two mutually rotatable discs for observing the turning movementof the head. Other contacts may be provided for observing inclination ofthe head or downward pulling of the jaw. In order to watch whether thetrainee opens the lid of the eye a further contact (not shown) isprovided at the point of application 43 of the thumb 45 opening theeyelid 44, and a writing instrument is associated with this contact.Approximately where the carotid artery is situated there is an imitationartery 46 the investigation by feel of which is likewise watched by afurther contact (not shown) associated with a writing instrument. Anartificial heart beat may also be produced in this imitation artery by arhythmic timer in the manner described above.

FIG. 7 shows diagrammatically the position of the heart 47 within thehuman thorax 48. The most effective heart compression coincident withthe least risk of fracture of ribs is achieved by pressure on the shadedregion 49 of the sternum 50. FIG. 8 shows two trainees practicing thecombined insufflation and heart massage technique on a dummy. The headof the dummy has been stretched backward so as to free the respiratorypassages; the correct positioning of the hand on the lower region of thesternum can be seen.

FIG. 9 shows an electromagnet in the form of a moving coil 51 having aspring loaded plunger type armature 52, i.e., an electromagnet such ascan be used for actuating the writing instruments 33, the pupil of theeye and for producing an artificial pulse in the imitation artery. Thereturn spring 53 is ahelical compression spring disposed between anenlargement 54 at one end of the plunger type armature 52 and theadjoining face of the coil. The spring ensures that the armatureprojects only slightly into the coil when the current to the coil isswitched off. A narrower and/or non-magnetic attachment 55 at the upperend of the armature symbolically represents a writing instrument 33, thepin 39 or a similar element. One end 56 of the winding of the coil 51 isconnected to one leaf spring 57 of a contact and the other end 58 of thewinding is connected to one pole of a source of electric energy (notshown), a wire 59 connecting the other pole to the other leaf spring 60of the contact. When the contact 57, 60 is closed by the exertion ofpressure in the direction of the arrow, current flows through the coil,the resulting magnetic field attracting the armature 52 into theinterior of the coil, counter to the force of the spring. The attachment55 arranged at the armature is thereby moved farther out of the coil 51.When, because the pressure is lifted and the leaf springs 57, 60resiliently separate, the flow of current is interrupted, the magneticfield collapses and the helical spring 53 returns the plunger typearmature to the original position illustrated.

FIG. shows a schematic cross-section through the body of the dummy, therecording equipment described with reference to FIGS. 1 to 4 beingcontained in the inner chamber of the body. An empty space 61 remainsbetween the boundaries of the inner chamber and the outer wall of thebody, an opening 62 giving access to the space 61. By filling this spacewith a pourable or flowable material such as water in this example, thedummy can be given a weight comparable to that of a human body so thatmanipulation of the dummy corresponds to conditions existing in reality.Conveniently the water is removed for transport and storage of thedummy.

Since the body of the dummy may be covered by clothing a means ofswitching the recording device on and off, such as a switch 63 on acable as here illustrated, is suitably provided exteriorly of the dummy.A bulb 64 for signalling readiness for use is associated with the switchand likewise unobstructed by clothing, so as to be readily visible.

With a view to realistic handling and so as to adapt the outerdimensions of the dummy to those of the human body, arms and legs arefitted to the torso of the dummy. Since, however, saving space is ofimportance when the dummy is being transported or stored, the lowerportions of the arms are adapted to be telescoped into the upper armsand the shinbone portions into the thighs, as shown in FIG. 11. In orderto preclude damage and lasting deformation while in storage, the wallsof the hollow limb portions are made of a resilientlydeformable-sponge-like material.

I claim:

l. Practicing apparatus for resuscitation by synchronized insuffiationand external heart massage, said apparatus comprising in combination:

a. a dummy torso;

b. imitation respiratory organs associated with said torso;

c. an imitation thorax associated with said torso;

d. a recording device adapted to receive and advance a record sheet inan advancing direction at substantially constant speed;

e. writing means adapted to write on said record sheet comprising firstand second independent writing instruments operable independently ofeach other; and

f. first linkage means connecting said first writing instrument to saidimitation respiratory organs to move said first writing instrumenttransverse to said advancing direction in responseto movement of saidimitation respiratory organs and second linkage means connecting saidsecond writing instrument to said imitation thorax to move said secondwriting instrument transverse to said advancing direction in response tomovement of said imitation thorax during insufflation and heart massage.

2. Practicing apparatus as claimed in claim 1, wherein said first andsecond linkage means effective to move said instruments each includes amechanical coupling disposed within said dummy torso and directlyexecuting substantially vertically directed movements occurring in thetorso during insufflation and heart massage.

' 3. Practicing apparatus as claimed in claim 1, wherein said dummyfurther includes means simulating the neck region, the area surroundingthe correct point of hand application when performing heart massage, aregion of pulse simulation and the region where the eyelid is situated,an actuating device associated with each said simulating means, and awriting member associated with each actuating device, effective toindicate on said record sheet whether said actuating device has beencorrectly actuated.

4. Practicing apparatus as claimed in claim 1, and further including arhythmic timer by means of which the reaction of the human body toresuscitation can be simulated in the manner of a predetermined variablesettable program.

5. Practicing apparatus as claimed in claim 1, and further including ahollow space in said dummy torso, a closable opening through which saidhollow space can be filled with a flowable material to simulate theweight of the human body, and dummy limbs attached to the torso.

6. Practicing apparatus as claimed in claim 1, wherein said imitationthorax includes a back portion of the dummy torso, a resilient elementsecured to said back portion and extending transversely of the torsoapproximately at the lower half of the sternum, and wherein said secondlinkage means to move said second writing instrument includes a rodconnected to said resilient member for movement therewith, means forguiding the rod in the direction of heart massage pressure substantiallyperpendicular to said back portion said rod being connected to saidresilient member for movement therewith.

7. Apparatus as claimed in claim 6, and additionally including resilientspring elements associated with said resilient member, effective toadjust the deformable characteristics thereof.

8. Practicing apparatus as claimed in claim 1, wherein said imitationrespiratory organs include an inflatable pouch, two walls to saidinflatable pouch, and said first linkage means includes a rod secured toone of said walls for movement therewith upon inflation of said pouch,said rod being connected to said first writing instrument.

9. Practicing apparatus as claimed in claim 8and further includingresilient means connected to said one wall of said pouch effective toresist inflation thereof.

1. Practicing apparatus for resuscitation by synchronized insufflationand external heart massage, said apparatus comprising in combination: a.a dummy torso; b. imitation respiratory organs associated with saidtorso; c. an imitation thorax associated with said torso; d. a recordingdevice adapted to receive and advance a record sheet in an advancingdirection at substantially constant speed; e. writing means adapted towrite on said record sheet comprising first and second independentwriting instruments operable independently of each other; and f. firstlinkage means connecting said first writing instrument to said imitationrespiratory organs to move said first writing instrument transverse tosaid advancing direction in response to movement of said imitationrespiratory organs and second linkage means connecting said secondwriting instrument to said imitation thorax to move said second writinginstrument transverse to said advancing direction in response tomovement of said imitation thorax during insufflation and heart mAssage.2. Practicing apparatus as claimed in claim 1, wherein said first andsecond linkage means effective to move said writing instruments eachincludes a mechanical coupling disposed within said dummy torso anddirectly executing substantially vertically directed movements occurringin the torso during insufflation and heart massage.
 3. Practicingapparatus as claimed in claim 1, wherein said dummy further includesmeans simulating the neck region, the area surrounding the correct pointof hand application when performing heart massage, a region of pulsesimulation and the region where the eyelid is situated, an actuatingdevice associated with each said simulating means, and a writing memberassociated with each actuating device, effective to indicate on saidrecord sheet whether said actuating device has been correctly actuated.4. Practicing apparatus as claimed in claim 1, and further including arhythmic timer by means of which the reaction of the human body toresuscitation can be simulated in the manner of a predetermined variablesettable program.
 5. Practicing apparatus as claimed in claim 1, andfurther including a hollow space in said dummy torso, a closable openingthrough which said hollow space can be filled with a flowable materialto simulate the weight of the human body, and dummy limbs attached tothe torso.
 6. Practicing apparatus as claimed in claim 1, wherein saidimitation thorax includes a back portion of the dummy torso, a resilientelement secured to said back portion and extending transversely of thetorso approximately at the lower half of the sternum, and wherein saidsecond linkage means to move said second writing instrument includes arod connected to said resilient member for movement therewith, means forguiding the rod in the direction of heart massage pressure substantiallyperpendicular to said back portion said rod being connected to saidresilient member for movement therewith.
 7. Apparatus as claimed inclaim 6, and additionally including resilient spring elements associatedwith said resilient member, effective to adjust the deformablecharacteristics thereof.
 8. Practicing apparatus as claimed in claim 1,wherein said imitation respiratory organs include an inflatable pouch,two walls to said inflatable pouch, and said first linkage meansincludes a rod secured to one of said walls for movement therewith uponinflation of said pouch, said rod being connected to said first writinginstrument.
 9. Practicing apparatus as claimed in claim 8 and furtherincluding resilient means connected to said one wall of said poucheffective to resist inflation thereof.